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Quiz Session - Attempts With Random Questions

NBCC NCMHCE Exam Questions

Page 3 of 33

41.

Use the following case study to answer this question.

How would you address the client's faith concerns as expressed in the second session? 

  • Supportively and non-judgmentally 

  • Ignore the faith issues, concentrating on treatment 

  • Agree that the client now no longer needs treatment 

  • Confront the religious ideas as denial 

Correct answer: Supportively and non-judgmentally 

Many clients have strong religious beliefs that the counselor must interact with in a supportive and non-judgmental way, even if those beliefs appear to run contrary to what is good for the client in a therapeutic sense from the counselor's perspective. 

However, the counselor is not obligated to agree with the conclusions of that faith as regards treatment. Confrontation about the religious beliefs as denial would most likely not be a productive therapeutic route, and the client's beliefs should not be ignored. 

42.

Use the following case study to answer this question.

What impact is the counselor's affect and appearance likely to have in this scenario?

  • Significant, given the client's dissociation 

  • Very little, given the client's flat affect 

  • The counselor's affect is unlikely to have an impact with clients 

  • Significant, and the counselor should match the client's affect

Correct answer: Significant, given the client's dissociation 

The counselor's appearance, mood, and affect are always likely to have some impact on the interactions and therapeutic process with clients. Counselors must be aware of how they present and be ready to change their presentation in response to circumstances if that change will help a client. In this case, the client has stated some symptoms of dissociation, and should be reassured by the counselor's affect and other communicative choices that he is in a safe place with a real person who can help.

The patient's affect can be variable. This client's flat affect does not require that the counselor match it, and by itself does not indicate that the counselor's choices about affective presentation will not have an impact. 

43.

Use the following case study to answer this question.

Which of the following is one of the purposes of the intervention about acknowledging the client's new role?

  • Grieving the loss of her old self 

  • Learning to love her baby

  • Acknowledging her inner struggle 

  • Repairing the relationship with her spouse 

Correct answer: Grieving the loss of her old self 

One indicated intervention for postpartum depression that is being used in this case is for the mother to acknowledge her new role. This has to do with grieving the loss of an old self and adjusting to a new and vastly different set of responsibilities. 

The intervention is not meant to help the client love her baby or repair her relationship with her spouse, and is not explicitly about an inner struggle.

44.

Use the following case study to answer this question. 

How would you define your role to this client? 

  • By explaining what you can do to help 

  • By addressing the client's anger 

  • By suggesting an intervention based on medication 

  • By defining counseling for the client 

Correct answer: By explaining what you can do to help 

Especially for clients who are naive to treatment, it is important to help them understand your role as a counselor. If possible, this should take place in an early session, but can involve discussions throughout treatment. In some cases, as in this one, the best route could be to explain your role by its utility to a client who does not appear to want to be in counseling and may not see its benefit but is apparently willing to try. This would be better than relating a standard, rote definition of counseling. 

The client's anger should be addressed, but this will not clarify roles. Suggesting medication may be necessary, but will not help the client understand how you can help per se. 

45.

Use the following case study to answer this question.

The client asks you a diagnostic question for which you do not have the answer in your mind. How should you respond? 

  • Admit you do not know the answer 

  • Give the best answer you have 

  • Consult with another professional 

  • Redirect to another topic 

Correct answer: Admit you do not know the answer 

Some aspects of genuineness can be threatening to counselors who have studied for years and who may have a great deal of experience. The advantage of genuineness is helping the client understand that the counselor is a real and trustworthy person. In this case, it would be best to admit you do not know the answer, rather than delaying, consulting with someone else, or giving an inadequate answer. Most clients will accept a small delay while a counselor comes up with the right answer, and it is an opportunity to build trust. 

46.

Use the following case study to answer this question.

Would it be acceptable to do distance counseling with this client?

  • Yes, distance counseling could be appropriate

  • No, distance counseling would not be appropriate for a child 

  • No, distance counseling would not be appropriate for this diagnosis 

  • Yes, distance counseling is appropriate for all clients

Correct answer: Yes, distance counseling could be appropriate

Distance counseling through telehealth is an emerging form of practice. Many issues are currently being worked out as it becomes more common, such as confidentiality. However, there is no reason why this client could not be served in this way. Such an approach might be more convenient for this family, which should be a consideration.

Telehealth is not appropriate for all clients; some may not like it, and others may have a presentation that disqualifies it. 

47.

Use the following case study to answer this question. 

Which of the following would be a possible indicator that this patient needs a higher level of care?

  • The client begins to have grooming failures

  • The client begins to talk in conspiratorial ways 

  • The client states that he feels threatened 

  • The client expresses anxiety about perceived threats 

Correct answer: The client begins to have grooming failures

A diagnosis is not a static assignment that never changes. A client's presentation can be indicative of a need to revisit diagnosis, or can offer clues as to a client's need for a higher level of care. In this case, the client usually has a fastidious appearance and has only recently been able to dress casually for sessions. If the client's behavior changes in this regard, that would be a step out of character that would be clinically worth investigating. It could mean the onset of other symptoms, or stress, grief, depression, or anxiety, among other considerations. Of the choices listed, grooming failure is the only one that suggests a major change in presentation; this could mean that the client is failing to keep themselves safe—the overriding concern for a change in level of care.

The rest of the choices are clinically congruent with paranoid personality disorder. However, in every case, it would be necessary to explore the magnitude of the conspiratorial thinking or the feelings of threat or anxiety.

48.

Use the following case study to answer this question.

With which of the following is the intervention strategy of rewards most congruent? 

  • Behavioral therapy

  • Cognitive behavioral therapy

  • Parent training 

  • Psychotherapy 

Correct answer: Behavioral therapy

As it is a system of specific rewards matched to specific desired behaviors, the chosen intervention plan is most congruent with a behavioral therapy intervention. This school of interventions also works on increasing the child's self-esteem.

A system of rewards is less congruent with cognitive behavioral therapy, parent training, or psychotherapy. 

49.

Use the following case study to answer this question.

How might positive regard help with this client? 

  • By helping with her feelings of worthlessness 

  • By encouraging her to participate 

  • By validating her existential anxiety 

  • By addressing her romantic problem 

Correct answer: By helping with her feelings of worthlessness 

Positive regard should be practiced with all clients to the extent possible. One's own feelings must sometimes be suppressed when serving clients who, in other respects, the counselor might not like, or who need a higher level of affective approval in the form of feedback for therapeutic purposes. The client should feel that they are a valuable person worthy of help. In this case, positive regard would directly help with the client's feelings of worthlessness. 

Positive regard may or may not help a client participate. It does not have the purpose in this case of validating existential anxiety or dealing with the client's relationship issues. 

50.

Use the following case study to answer this question.

Which of the following would be the most likely focus of cultural considerations for this client?

  • Family culture 

  • Local culture 

  • White culture 

  • Culture of sexuality 

Correct answer: Family culture 

Cultural considerations in treatment can refer to much more than issues around race and ethnicity. Even in cases where the patient presents from a "dominant" culture, there will most likely be cultural differences that should be addressed. In this case, the patient's family culture seems to have deeply affected their life by not being a source of trust and compassion, and is therefore of clinical interest relevant to the presenting problem. The patient has refused to answer questions about sexuality; unless they bring it up or there is some other compelling therapeutic reason to do so, this boundary should be respected. 

Local culture and white culture do not seem to be as significant in this case as the family culture of the patient.

51.

Use the following case study to answer this question.

What is the best way to find out if there are cultural issues at work in this case? 

  • Ask a broad, culturally-sensitive question

  • Wait until the client suggests it 

  • Administer a standard questionnaire 

  • There are no cultural issues in this case 

Correct answer: Ask a broad, culturally-sensitive question

There is little harm in openly addressing culture with clients, if it is done with sensitivity. In fact, without asking such a question, many cultural issues relevant to the case might go unnoticed. Many people might not think to openly discuss their own culture unless prompted, as they take it naturally as an assumed part of their life. 

In a clinical context, the counselor is responsible for gathering whatever information is needed, including cultural issues. It is better to address the issue openly and sensitively rather than using a standard questionnaire that assumes culture is relevant to the case in some way. We do not know that culture is or is not relevant to this case with the information provided. 

52.

Use the following case study to answer this question. 

How is malingering different from somatic symptom disorder? 

  • Somatic symptom disorder is not voluntary

  • Somatic symptom disorder is voluntary

  • Malingering is not voluntary

  • Malingering involves clinical anxiety

Correct answer: Somatic symptom disorder is not voluntary 

In somatic symptom disorder, the individual experiences a distressing physical symptom which is not explained by a medical cause, which can be dramatic and overstated. However, their experience is real, particularly in the anxiety they feel about their symptom. 

Malingering, on the other hand, is voluntary and does not diagnostically contain an element of clinical anxiety.

53.

Use the following case study to answer this question.

Which of the following statements would best demonstrate congruence to this client? 

  • "I'm sitting here with you and I am interested in how you're feeling."

  • "Don't worry, I am very qualified to deal with your issue."

  • "Can you tell me about your experience being Black?"

  • "You made a good choice coming to therapy."

Correct answer: "I'm sitting here with you and I am interested in how you're feeling."

Congruence in therapy refers to the ability on the part of the therapist to be real and present during the session, and not hide behind professional qualification. It is an important reinforcer to the therapeutic duad for the client to understand that, aside from their professional responsibility, the counselor is a real human being who is happy to try to help the client.

The other responses stand on qualification, force the client to take on the burden of explaining their ethnicity, or simply reinforce the client for their choice to attend therapy. It is much better to create a sense of real, human connection with the client. 

54.

Use the following case study to answer this question.

Which of the following would be the most appropriate short-term goal for this client?

  • Learning strategies for dealing with intrusive thoughts 

  • Contacting family for their assistance 

  • Finding out more about the homicide from the police

  • Conducting a job search in case he loses his employment due to symptoms 

Correct answer: Learning strategies for dealing with intrusive thoughts 

It is important for counselors and clients to establish reasonable short- and long-term goals for treatment. Good short-term goals are things clients can achieve in the near term that will have a direct effect on their distress or undesirable circumstances. In this case, the best short-term strategy is to find a way to help the client with their intrusive thoughts. There are some basic strategies that can be learned quickly and put into practice. 

Contacting family may or may not be called for, but, by itself, is not a goal. Finding out more about the homicide is likely not the desirable therapeutic direction, as it may retrigger the traumatic memories and police may or may not be receptive to this request. A job search may or may not be necessary, and is a longer-term goal.

55.

Use the following case study to answer this question.

How does schizophreniform disorder mainly differ from schizophrenia? 

  • In duration of symptoms 

  • Schizophrenia has delusions, while schizophreniform disorder does not 

  • Schizophreniform disorder has delusions, while schizophrenia does not 

  • Schizophrenia is not characterized by disorganized speech 

Correct answer: In duration of symptoms

Schizophreniform disorder differs from schizophrenia mainly in the duration of the symptoms, which include delusions, hallucinations, and disorganized speech. In order to qualify for a diagnosis of schizophreniform disorder, the symptoms last from one month to six months. 

56.

Use the following case study to answer this question.

Is it ethical to document this client's cancellations? 

  • Yes, it is ethical to document cancellations

  • No, it is unethical to document cancellations

  • Only if the client gives consent

  • Yes, but you must inform the client afterward

Correct answer: Yes, it is ethical to document cancellations

In any case, it is ethical to document a client's pattern of attendance in therapy. In this case, the pattern of cancellation may have some clinical significance, as it could be a reflection of the patient's narcissism.

A client has rights concerning their documentation, but they do not have control over your documentation of their pattern of attendance. Though your client can request records, there is no specific ethical mandate that you inform a client about this issue. 

57.

Use the following case study to answer this question.

How would Parent Child Interaction Therapy (PCIT) benefit this client?

  • PCIT can assist with improving relationships and decreasing negative behavior

  • PCIT would not be used with this client due to their bullying 

  • PCIT would not be used with this client due to their age 

  • PCIT can assist with controlling triggering thoughts and impulses 

Correct answer: PCIT can assist with improving relationships and decreasing negative behavior

Parent Child Interaction Therapy (PCIT) is an evidence-based set of interventions for children with behavioral problems. In this case, it could be used to improve family relationships and decrease this client's negative behavior.

PCIT is not contraindicated in clients who bully, and this client is not disqualified due to age. Controlling triggering thoughts and impulses would be more like cognitive behavioral therapy (CBT).

58.

Use the following case study to answer this question. 

Do any of the client's behaviors so far indicate a lack of age-appropriate functioning?

  • No, so far her developmental presentation seems age-congruent 

  • Yes, as her need for attention infantilizes her 

  • Yes, as her need for attention renders her unstable 

  • No, as long as her need for attention does not become acute 

Correct answer: No, so far her developmental presentation seems age-congruent 

At least as far as the information given, there is no indication that the client is not acting in a way that is incongruent with her developmental level. Her need for attention is related to her diagnosis, but it does not necessarily infantilize her or render her completely unstable. However, her need for attention is in some ways acute as part of her diagnostic presentation. 

59.

Use the following case study to answer this question. 

Which of the following is most likely to change the treatment plan for this client? 

  • The client not being able to graduate 

  • The client not making progress 

  • The client's writing his feelings in a notebook

  • The client's nonverbal communication 

Correct answer: The client not being able to graduate 

Treatment planning takes place in the context of a patient's life, with all its complications and change. The patient has just received what seems to be devastating news, which is that, in spite of the progress made in the client's behavior, the client still will not graduate high school at this time. This development is likely to have a cascade of consequences for the client and his family, which may change the focus of treatment and, therefore, the treatment plan. 

The client is making progress, as evidenced by the behavior changes in school and his use of a key coping skill. His nonverbal communication is unlikely to be grounds to change his treatment plan on its own. 

60.

Use the following case study to answer this question. 

If the client appears with a problem that is not the problem they think they have, is it ethical to treat them?

  • It is ethical to attempt to provide assistance 

  • Is is unethical to engage with a client with factitious disorder 

  • It is ethical to treat the client's factitious illness 

  • It is unethical not to treat the client's factitious illness 

Correct answer: It is ethical to attempt to provide assistance 

Illnesses such as factitious disorder pose an ethical problem from a certain standpoint. The client will wish for treatment, but may be seeking treatment for a condition they may not have. In these cases, it is ethical to attempt to provide the client assistance in some form. The client may not like what you have to offer, but it would be unethical to treat a factitious illness as an actual illness in most cases. 

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